Public Health Dental Hygiene Dental (PHDHP) Survey
I. DEMOGRAPHICS
1.
Location of personal residence (zip code)
2.
Location of primary practice site (zip code)
3.
Do you currently hold a PHDHP license?
YES
NO
4.
If answered YES to Question #3, list license number and date issued:
5.
Are you eligible for PHDHP licensure?
YES
NO
NOT SURE
6.
Do you currently hold a Local Anesthesia license?
YES
NO
7.
If answered YES to Question #6, list license number and date issued:
8.
Are you currently a School Certified Dental Hygienist?
YES
NO
9.
Are you currently a Member of the ADHA?
YES
NO
Current Progress,
0 of 28 answered
